The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 11, 2009 #3,490 Publisher-Barry Block, DPM, JD

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VA Podiatrist Discusses Plantar Fasciitis

“Typically, plantar fasciitis is an overuse injury, whether it’s from someone athletic or someone who does a lot of standing,” says Dr. Sonya Faircloth, a podiatrist with Foot and Ankle Specialists of Virginia. Faircloth notes that the typical scenario is significant pain after periods of inactivity such as “that first step in the morning or after you have been sitting at your desk a while.” Faircloth says that the inflamed plantar fascia tears away from the middle portion of the heel bone and causes pain in the arch and heel, pain that patients often misinterpret as a heel spur. 

Faircloth adds that if plantar-fasciitis patients do not respond to treatment in four to five weeks, surgical intervention is an option. “You surgically release the plantar fascia,” she says, adding that patients should be back in a regular shoe in two to five weeks post-surgery, depending on the type of procedure. However, Faircloth says that if one has plantar fasciitis, wearing a small heel can actually help with the painful symptoms. She encourages wearing shoes with arch support, which can be easily identified by feeling the inside of a shoe before purchase.

Source: Bethany Emerson, Richmond Magazine [March, 2009]
 

Two OH Podiatrists Elected Chiefs of Podiatry

Two podiatric physicians have been elected to lead the podiatry divisions of the medical staffs at St. Elizabeth Health Center’s main and Boardman facilities. Dr. Lawrence A. DiDomenico, managing partner at Ankle & Foot Care Centers, the region’s largest podiatry practice, has been elected chief of podiatry at St. Elizabeth’s main campus in Youngstown. Dr. Kenneth J. Emch, a partner at Ankle & Foot Care Centers, has been elected chief of podiatry at St. Elizabeth’s Boardman campus on McClurg Road.

Dr. Lawrence A. DiDomenico

DiDomenico is a board-certified podiatric physician, surgeon and wound specialist, and has practiced in the Youngstown area since 1991. DiDomenico has delivered numerous lectures to podiatrist gatherings in the United States, Western Europe, and Russia.

Dr. Kenneth J. Emch

Emch also is a board-certified podiatric physician & surgeon and wound specialist, and has practiced in the Youngstown area since 1993. He holds a doctor of podiatric medicine degree from the Ohio College of Podiatric Medicine in Cleveland.

Source: The Metro Monthly [March 2009]
 

Query: Voice Recognition Software

Which voice recognition software systems are currently recommended? 

Tom DeBenedictis, DPM, Union City, NJ

Query: Night Splint Billing

A night splint was dispensed to a Medicare patient. Since we are not DMERC providers and the night splint is not a covered item, I had the patient sign a Medicare advance beneficiary notice (ABN). I billed the claim as follows: L4396, added a "GA" modifier to show wavier on file, and added an "LT" to show which foot it was for and used ICD-9 728.71 (plantar fasciitis, traumatic).

The explanation of benefit I received stated that there was a missing or incorrect modifier. I called Medicare, and they stated I should try billing it without "LT" modifier. It still was denied. In the past, I did not have any problems with this. Has anything changed?

Lisa Maynard, New York, NY

Response: A night splint is a covered item under the Medicare program. Your practice not being DMERC providers is the issue. If the patient is willing to pay out-of-pocket without expectations of being reimbursed from Medicare, the patient can choose "Option 2" on the new mandatory advance beneficiary notice (ABN). There are no appeal rights for the patient.

If you did not do this, I am surprised your previous claims were paid by Medicare since you said you were not a DMERC provider.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Procardia Topical (Wm. Barry Turner, RN, DPM)
From: Sloan Gordon, DPM

If you are seeking a topical "vasodilator", why not choose Nitrodur disks at 0.2 mg/hr x 12 hours daily? That's what many CV surgeons and interventional cardiologists, as well as DPMs, do here. It seems to work quite well. Oddly enough, I find pentoxyfyline (orally) to be quite effective in wound healing, as well. 

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
 

RE: Podiatry Must Speak With One Voice
From: Judith E. Rubin, DPM

What is our plan as a profession? We talk about such small things, like how to squeeze out more money from an office visit by becoming retailers of products rather than making the money we do from every office visit. If I have learned anything from being in practice, from bad times in Texas to good times, back to bad times, it is that sitting around wondering if we are all going to become cobblers to make a living is absolutely not the answer! It is time that we all stood up for ourselves as a profession, not fragmented, but in ONE LOUD VOICE. Let the insurance companies and Washington know that we are standing together, proud as a profession, and will not let them return us to being chiropodists, but the heavily surgically-trained doctors that we are. We will not turn on each other, like the lawyers want us to do, to make that extra buck (and shame on the ones that do and you know who you are).

We will not back down. We are as important a profession as any other medical specialty. We have worked harder to get where we are than any other profession. We cannot be replaced with P.A.'s and N.P.'s; so Medicare, Medicaid, private insurers, and the AMA, get ready, because we have just begun to fight! We should write to the President as a profession, write to the insurers, as a profession, and let them know in no uncertain terms, that WE ARE HERE TO STAY AND WE ARE A FORCE TO BE RECKONED WITH!  

Judith E. Rubin, DPM, Cypress, TX, jrubinfoot@aol.com

RE: What to do in the Face of the Projected Medicare Cuts? (Jeffrey Kass, DPM)
From:  Multiple Respondents

I might be willing to take a 20% cut in Medicare reimbursements if the President, members of congress and all other federal employees took a 20% cut in their salaries as well. But that's not going to happen.

Doug Milch, DPM, Asheville, NC, LDMilch@charter.net

Although I, along with Dr Kass, am concerned about the projected physician payment reductions, I want the facts to speak for themselves. The Obama Administration is not where the blame lies. The Balanced Budget Act of 1997 stipulated that a Sustainable Growth Rate (SGR) replace the Medicare Volume Performance Standard. It specified the formula for establishing yearly SGR targets for physician services under Medicare.

The SGR has an automatic 21% cut set to occur on January 1, 2010 just like the automatic 10.6% cut established for 2008. The SGR formula is obviously not working! The fact that Congress keeps overriding it speaks for itself. President Obama's budget for 2010 would actually provide $329.6 billion in funding for the next 10 years to block reductions in physician payments by Medicare.

Obama's director of the Office of Management and Budget clearly stated that "Congress would never allow (the cuts) to happen, and each year, they would fill in the hole, even though it had not been budgeted for." (February 26, 2009 White House briefing) He continued to state that "We don't want to pretend that we are going to reduce Medicare physician payments rates by 20% next year.  We are going to show in the budget the cost of filling in the hole created by the SGR formula." I am not an expert in Medicare, but the facts are clear.
 
Steve Bennett, DPM, Kearney, NE, sbennettdpm@charter.net

Calling for "scrambling" from our leaders falls short as an isolated plan for the future of your practice. Does any one reader expect that he/she can sit idly by and survive this moment? Medicare cuts do not concern me.  What concerns me are the ostrich DPM's bury who their collective heads in the sand. The most productive times for creating market share and implementing positive change are bad times.

Do you have website? Are you dropping out of your poorest paying plans?  Do you still perform routine foot care and bill bunions and hammertoes instead of demanding payment directly from your non-diabetic and non-PAD patients? Have you looked for a new strategy when it comes to wounds, orthotics, injection therapy or prescribing? Do you in-office dispense? Have you invested in new technology or premium services. Have you upgraded your office environment or staff recently? Do you have an outreach program into the medical community?

When the next round of Medicare cuts come through, some of us will not survive, some of us will survive, and some of us will thrive. What are you doing personally to impact where you land? This is a great time to invest energy and money into your practice, proactively, in order to grow your patient numbers, the quality of your care, and your bottom line.

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com
 

RE: PM Podiatry Hall of Fame
From: Lynn Homisak, PRT

When I worked for Dr. Roy LaBarbera during his APMA Presidency, it was always fun to receive one of John Carson's phone calls. We'd chat for half a minute; then (with a patient standing at the front desk) I would dial the doctor to say, "Doctor, Johnny Carson is on the phone for you!" The patient’s eyes would light up and I would just smile. I have not seen or spoken to John for some time now, but I will never forget him! To me, he has always represented class and integrity. He not only talked the talk, but walked the walk for our podiatric profession. It's nice to see he is finally getting the recognition he deserves. 

Congratulations to both him and Dr. Hal Ornstein!

Lynn Homisak, PRT, Seattle, WA
 

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

ASSOCIATE POSITION – HOUSTON, TX

Associate needed for 30 Year Houston practice. 2 offices, each located in growing medical center. Heavy surgical/office practice with minimal RFC. Tremendous opportunity for personable self starter. English & Spanish would be a big asset.PM&S-24 and PM&S-36 graduate welcome. Texas license required. Reply to ssssmosk@aol.com

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

ASSOCIATE POSITION- CALIFORNIA

Associate needed for coverage in the office, nursing homes and facilities in Orange County Southern California. Surgical as well as C&C. Will help to get on staff at St. Jude Medical Center. Please contact Dr. Lee for more information at (714) 333-5837 or by e-mail to chinuklee@yahoo.com

ASSOCIATE POSITIONS – CALIFORNIA

Three podiatrists needed for busy North Hollywood office. Full-time Monday-Friday 8am-2:30pm.  No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION – NAPLES, FL

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

PRACTICE FOR SALE-SOUTHEAST MICHIGAN-BRIGHTON
 
Outstanding opportunity. Eleven year established. Excellent location in mid to high income growth area. Must sell due to illness. Turn-key, all equipment and furniture included. Beautiful 1,350 sf build-out. Great visibility and parking. Priced low to sell immediately. Call (248) 565-5266. Docpod@aol.com 

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

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